Kim Yong-Ha, Jung Dong-Woo, Kim Tae Gon, Lee Jun Ho, Kim Il-Kug
Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea.
J Craniofac Surg. 2013 Jul;24(4):1118-22. doi: 10.1097/SCS.0b013e318290266a.
Repairing orbital wall fractures can result in serious complications, including enophthalmos, diplopia, or even blindness. Especially, surgeons worry about damaging the optic nerve while dissecting the optic canal area. We avoid these complications by using a navigation system that was adapted to stereotactic concept based on three-dimensional imaging of the patient's anatomy. Here, we report 5 cases of orbital wall fracture that were repaired using a navigation system.
The Navigation System II (Stryker, Freiburg, Germany) and the iNtellect Cranial Navigation (version 1.1) platform were used for each operation. A computer-assisted navigation surgery was performed according to the following procedures: (1) image set, (2) planning, (3) apparatus setup, (4) registration, and (5) intraoperative navigation. Operations were performed under general anesthesia. Dissection was performed up to the periosteum immediately anterior to the optic canal, near the fracture. Vulnerable surrounding structures were identified with the intraoperative pointer. After navigation, we inserted an implant into the defect, successfully, avoiding damage to the optic canal and optic nerve.
None of the patients had any surgical complications. Postoperative computed tomography scans demonstrated that the fractures were corrected, and continuity was maintained without displacement. The three-dimensional image allowed us to easily visualize intraoperative anatomical structure, allowing us to avoid unnecessary procedures and to correct the orbital wall. The mean volume of fractured orbital cavity was 29.2 cm(3) (range, 28.3-30.4 cm(3)) preoperatively and 27.0 cm(3) (range, 25.9-28.5 cm(3)) postoperatively; thus, the defects were corrected by 2.2 cm(3) (range, 1.3-2.8 cm(3)) on average.
We used a navigation system to perform accurate and safe surgery in patients with extensive orbital wall fracture, including around the optic canal. By using the functions to visualize the locations indicated by the pointer, we were able to perform successful dissections and implantations in areas adjacent to the optic canal. The good outcomes obtained here provide evidence that surgical correction of the orbital wall using a navigation system is useful in cases of deep, extensive orbital wall fracture.
修复眼眶壁骨折可能导致严重并发症，包括眼球内陷、复视，甚至失明。特别是，外科医生在解剖视神经管区域时担心损伤视神经。我们通过使用一种基于患者解剖结构三维成像并适应立体定向概念的导航系统来避免这些并发症。在此，我们报告5例使用导航系统修复的眼眶壁骨折病例。
每次手术均使用第二代导航系统（德国弗莱堡施乐辉公司）和iNtellect颅脑导航（1.1版）平台。计算机辅助导航手术按以下步骤进行：（1）图像采集，（2）规划，（3）设备设置，（4）注册，以及（5）术中导航。手术在全身麻醉下进行。在骨折附近，解剖至视神经管前方紧邻的骨膜处。用术中指针识别周围易受损结构。导航后，我们成功地将植入物插入缺损处，避免了对视神经管和视神经的损伤。
所有患者均未出现任何手术并发症。术后计算机断层扫描显示骨折得到矫正，连续性得以维持且无移位。三维图像使我们能够轻松地可视化术中解剖结构，从而避免不必要的操作并矫正眼眶壁。术前骨折眼眶腔的平均体积为29.2立方厘米（范围为28.3 - 30.4立方厘米），术后为27.0立方厘米（范围为25.9 - 28.5立方厘米）；因此，缺损平均矫正了2.2立方厘米（范围为1.3 - 2.8立方厘米）。
我们使用导航系统对包括视神经管周围在内的广泛眼眶壁骨折患者进行了准确、安全的手术。通过利用可视化指针指示位置的功能，我们能够在视神经管附近区域成功进行解剖和植入操作。此处获得的良好结果证明，在深部、广泛眼眶壁骨折病例中，使用导航系统进行眼眶壁手术矫正很有用。
